Revealed: the confidential details of the National Health Insurance plan.

In his State of the Nation address in 2009, President Jacob Zuma announced the introduction of a National Health Insurance system. We're in possession of the confidential document in which an ANC task team sets out its NHI plan. Here are the key points. By Mari Hudson, for What’s New DOC

An increase of 40% in the health budget, funded by a substantial increase (some economists predict an increase of 58%) in taxes paid by each and every taxpayer (general taxes, plus a mandatory pay roll levy), is needed to establish the ANC’s proposed National Health Insurance (NHI) system.

In exchange, consumers will get: three visits per year to a state-contracted GP in the district where they’re registered, strict centrally controlled referrals to specialists (preferably to public hospitals), and all your confidential medical records electronically available to everybody involved in the NHI.

These are just a few of the implications of the proposals set out in the confidential ANC document titled “The National Health Insurance Plan for South Africa”, prepared by the party’s NHI task team and dated 16 February 2009. The task team was headed by former director-general of health Dr Olive Shisana, who is apparently positioning herself to become head of the NHI. This NHI Plan was drafted on behalf of the ANC health and education subcommittee. The subcommittee was headed by Dr Zweli Mkize, Zuma confidant and new KwaZulu-Natal premier.

'Cementing social solidarity"
The task team describes its NHI Plan as “a mechanism for cementing social solidarity in the health system”, where the rich subsidise the poor and the healthy subsidise the ill.

According to time frames set out in this document, and the Department of Health Strategic Plan for 2009-2011, Shisana plans to draft the proposals into a new NHI bill within the next nine months. Allegedly Shisana has already tasked Debbie Pearmain, legal representative of the Board of Healthcare Funders, to formulate draft legislation.

At the time of going to print, the full NHI document was not yet in the public domain and discussions with role players such as private funders and medical schemes had not yet started. However, it is obvious that Shisana, Cosatu and the SACP do not intend to waste any time.

A speedy process
This apparent need for speed was reiterated by the ANC secretary-general Gwede Mantashe on 12 May when he stated, “The NHI must be in place within the first year of this term and continue to improve over the next five years,” clearly referring to the NHI document.

ANC spokesperson Jesse Duarte slammed the media reports on the secret document and plans, and vowed: “We will transform health care in South Africa and will not be deterred by narrow interest groups and individuals bent on undermining the introduction of NHI before its work is made public.” Read Jesse Duarte's reaction on News24.

But not everything adds up. There are three documents floating around. The new health minister, Dr Aaron Motsoaledi, referred to the “road map” to address the “glaring faults” in the public health system, but it is unclear whether he means the NHI document, the Strategic Plan document or a third document called “A Roadmap for the Reform of the South African Health System”.

This third document was drawn up at a meeting of government, private sector stakeholders and the Development Bank.

The rehabilitation of public hospitals
President Zuma stated at the opening of Parliament that “we are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.” He announced that “to initiate the NHI, the urgent rehabilitation of public hospitals will be undertaken through public-private partnerships.”

However, in the NHI document, there is surprisingly little reference to the private healthcare sector. Although there are no plans to actively dismantle the private health sector – as former health minister Barbara Hogan promised and Motloasedi confirmed in public – it seems clear that the survival of private healthcare services (GPs, specialists, pathology laboratories and hospitals) who choose not be contracted by the NHI Authority is of little consequence to the task team.

But there can be no doubt that a huge tax increase will leave many taxpayers too cash-strapped to afford additional medical aid premiums, resulting in the shrinkage of the private healthcare sector and a further exodus of doctors, as well as of private hospitals and pharmaceutical companies.

This is an edited extract of an article that originally appeared in What's New DOC, the new magazine for doctors produced in association with Health24.

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